The NHS is much-loved – given its societal principles and formal constitution – and so recent headlines announcing that it is ‘broken’ carry a lot of emotion. Many of us have direct or indirect experience of the care and kindness it provides without question or prejudice.  

 

Even those who question this broken status would admit that it’s stretched beyond its limits in places and the new government’s approach has been to carry out an ‘honest and raw’ review of the health service (the Darzi report) which will inform a 10-year plan for the NHS due out this Spring. Lord Darzi outlined that the NHS is in critical condition due to increasing demand, ageing infrastructure, and widening health inequalities. These are important considerations and it’s important to acknowledge that some of the solutions exist outside the service itself, as we ask ourselves how we can lead healthier lives. 

 

Architects are trained to find solutions to complex problems, often concerned with improving people’s lives. My particular field of expertise is health, science and education buildings, ideallybringing all three together to improve health outcomes for communities. The delivery of Darzi’s reportcoincided with the publication of the Grenfell Inquiry and it occurred to me that there is a paradox in the way we talk about the built environment. There is real concern that our hospitals and housing aren’t fit-for-purpose, as they are simply not capable of providing the necessary safety and security.Simultaneously, the government is promising very real and radical reforms to the planning system in a bid to ensure “ambitious housing targets” are met. This begs the question: how does the quality of our built environment affect our health and consequentially how can it improve the chances of our NHS surviving this moment in its history? 

 

While much of the discourse about the NHS revolves around increasing funding and improving management structures, there are broader societal questions raised in the Darzi report– why do we rely on the NHS so heavily? Is there too much demand for its services and should we all try to use it more sparingly? It seems evident that the state of our health is more important than the state of our healthcare estate. 

 

Being healthy is more than just being free from disease; it encompasses physical, mental, and social wellbeing. Designing for health means building places and spaces that enable resilient, accessible, trusting and co-operative communities to thrive. We should be talking about how buildings and places can build health - healthier people lead healthier lives and rely on the health service less and less. Better built environments have the potential to dramatically relieve pressure on the NHS and shift focus towards health creation and improved social cohesion. 

 

Florence Nightingale was a healthcare pioneer and her book ‘Notes on Nursing’ remains influential to this day. She knew that people-centric environments made a meaningful difference, and she emphasised the importance of hygiene, cleanliness and good ventilation as well as explaining that access to fresh air, clean water, light and proper sanitation were essential for health and recovery. It seems so simple now, and yet we’ve somehow allowed ourselves to forget many of these principlesin our everyday lives. The modern built environment is no different and we still require well-designed and managed spaces to improve our physical and mental wellbeing. 

 

 

We were inspired by the Maggie’s Centres – a network of beautiful spaces that provide support for people with cancer (and their families) to cope with their diagnosis and treatment – when we produced plans for the Rare Dementia Support Centre, which has just received planning consent. It shows how thoughtfully curated architectural interventions can help provide care for those with uncommon conditions, while incorporating world-leading research and educational facilities. Working alongside UCL, its establishment will be a world first but it draws upon and adapts the principles that remind us what it is to be human and provide an environment where care and mental respite come first. 

 

 

Too many people end up in hospitals because there is insufficient infrastructure in society for preventative care – simply put our health isn’t good enough. Designing places and spaces that improve health can mitigate this. Good design in the built environment won’t solve all the problems of the NHS, but it has the power to promote local engagement, provide positive outlooks and improve local health levels and social cohesion – all of this will improve the chances of survival for the NHS. 

 

We can all do better. The built environment is a fundamental pillar of public health. Architects, urban designers, engineers, developers, planning officers, public sector decision makers, the government and local authorities all have a duty to consider its impact on population health. 

 

We need to design spaces collaboratively that serve society and think beyond the boundaries of any individual building or project. The immediate need of the NHS may well include new or refurbished buildings, but a broader, longer-term view on improving health needs to be our focus.

 

By designing buildings and places that are focused on our physical and mental wellbeing, we can shift the burden away from the NHS and build a healthier, more resilient society.